RESUMO
This study examined the association of clinical factors, independent of sex and high psychosocial adversity (HPAd), with the presence of ADHD or other mental disorders, specifically within a middle-income country with a non-Caucasian population. A multi-centric cross-sectional study was conducted in three sites in Colombia. Our study recruited trios of an ADHD proband, one sibling, and one parent. We used valid instruments for assessing parents and siblings. The sample included 223 siblings, an average age of 12.3 (SD 3.9), and 51.1% Females. The ADHD recurrence risk ratio (λ) was 12. The clinical factors mainly associated with the presence of ADHD, independent of sex and HPAd, were 1) Pregnancy and childbirth complications, 2) Delayed psychomotor development, 3) Temperament, and 4) Sleep disturbances. Our research showed that, independently of HPAd and the male sex, there were other clinical factors associated with ADHD and other psychiatric disorders in this population. These findings need to be replicated in similar populations globally.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtornos Mentais , Irmãos , Humanos , Feminino , Masculino , Colômbia , Irmãos/psicologia , Estudos Transversais , Criança , Adolescente , Transtornos Mentais/epidemiologia , Fatores Sexuais , Experiências Adversas da Infância/estatística & dados numéricos , Fatores de RiscoRESUMO
INTRODUCTION: Lithium treatment of bipolar disorder (BD) has been associated with less cognitive impairment and fewer changes in structural brain anatomy compared to other treatments. However, the studies are heterogeneous and few assess whether these effects are related. The objective of this study was to evaluate and relate cognitive performance and structural neuroanatomy in patients treated with and without lithium. METHODS: Cross-sectional study that included 48 subjects with BD-I, of which 22 were treated with lithium and 26 without lithium. Performance was assessed on Wechsler III (WAIS III), TMT A and B (Trial Making Test) neuropsychological tests, California verbal learning test (CVLT), Rey complex figure test and Wisconsin card sorting test. Brain structures obtained by magnetic resonance imaging (MRI) were evaluated. The standardised mean difference (SMD) between both groups was calculated, adjusted for confounding variables using a propensity score, and the Spearman correlation coefficient (ρ) was used to assess the relationship between cognitive performance and neuroanatomical regions. RESULTS: Compared to the group without lithium, the group with lithium had fewer perseverative errors in the Wisconsin test (SMDâ¯=â¯-0.69) and greater left and right cortical areas (SMDâ¯=â¯0.85; SMDâ¯=â¯0.92); greater surface area in the left anterior cingulate (SMDâ¯=â¯1.32), right medial orbitofrontal cortex (SMDâ¯=â¯1.17), right superior frontal gyrus (SMDâ¯=â¯0.82), and right and left precentral gyrus (SMDâ¯=â¯1.33; SMDâ¯=â¯0.98); greater volume of the right amygdala (SMDâ¯=â¯0.57), right hippocampus (SMDâ¯=â¯0.66), right putamen (SMDâ¯=â¯0.87) and right thalamus (SMDâ¯=â¯.67). In the lithium group, a correlation was found with these errors and the thickness of the left precentral gyrus (ρâ¯=â¯-0.78), the volume of the right thalamus (ρâ¯=â¯-0.44), and the right amygdala (ρâ¯=â¯0.6). CONCLUSIONS: The lithium group had better cognitive flexibility and greater dimension in some frontal and subcortical cortical regions. Furthermore, there was a moderate to high correlation between performance in this executive function and the thickness of the right precentral gyrus, and the volumes of the thalamus and the right amygdala. These findings could suggest a neuroprotective effect of lithium.
Assuntos
Transtorno Bipolar , Transtorno Bipolar/tratamento farmacológico , Cognição , Estudos Transversais , Humanos , Lítio/uso terapêutico , Transtornos do Humor , NeuroanatomiaRESUMO
RESUMEN Introducción: El tratamiento del trastorno afectivo bipolar (TAB) con litio se ha relacionado con menos deterioro cognitivo y menores cambios en la anatomía estructural cerebral comparado con otros tratamientos. Sin embargo, los estudios son heterogéneos y son pocos los que evalúan si estos efectos están relacionados. El objetivo de este estudio es evaluar y relacionar el desempeno cognitivo y la neuroanatomía estructural en pacientes tratados con y sin litio. Métodos: Estudio de corte trasversal que incluyó a 48 sujetos con TAB I: 22 tratados con litio y 26 sin litio. Se evaluó el desempeno en las pruebas neuropsicológicas Wechsler III (WAIS III), TMTAyB (Trial Making Test), prueba de aprendizaje verbal de California (TAVEC), prueba de Figura compleja de Rey y prueba de clasificación de tarjetas de Wisconsin. Se evaluaron estructuras cerebrales obtenidas por resonancia magnétiva (RM) cerebral. Se calculó la diferencia de medias estandarizada (DME) entre ambos grupos, con ajuste por variables de confusión mediante puntuación de propensión, y se empleó el coeficiente de correlación de Spearman (p) para evaluar la relación existente entre el desempeno cognitivo y las regiones neuroanatómicas. Resultados: Respecto al grupo sin litio, el grupo con litio tuvo menos errores perseverativos en el Wisconsin (DME = -0,69) y mayores áreas corticales derecha e izquierda (DME = 0,85 y DME = 0,92); mayor superficie en el cíngulo anterior izquierdo (DME = 1,32), la corteza orbi-tofrontal medial derecha (DME = 1,17), el giro frontal superior derecho (DME = 0,82), los giros precentrales derecho e izquierdo (DME = 1,33 y DME = 0,98); mayor volumen de la amígdala derecha (DME = 0,57), el hipocampo derecho (DME = 0,66), el putamen derecho (DME = 0,87) y el tálamo derecho (DME = 0,67). En el grupo con litio, se encontró una correlación con dichos errores y el espesor del giro precentral izquierdo (p = -0,78), el volumen del tálamo derecho (p = -0,44) y la amígdala derecha (p = 0,6). Conclusiones: El grupo con litio tuvo mejor flexibilidad cognitiva y mayor dimensión en algunas regiones corticales frontales y subcorticales. Además, hubo correlación moderada a alta entre el desempeno en esta función ejecutiva y el espesor del giro precentral derecho, y los volúmenes del tálamo y la amígdala derecha. Estos hallazgos podrían indicar un efecto neuroprotector del litio
ABSTRACT Introduction: Lithium treatment of bipolar disorder (BD) has been associated with less impairment and fewer changes in structural brain anatomy compared to other treatments. However, the studies are heterogeneous and few assess whether these effects are related. The objective of this study was to evaluate and relate cognitive performance and structural neuroanatomy in patients treated with and without lithium. Methods: Cross-sectional study that included 48 subjects with BD-I, of which 22 were treated with lithium and 26 without lithium. Performance was assessed on Wechsler III (WAIS III), TMT A and B (Trial Making Test) neuropsychological tests, California verbal learning test (CVLT), Rey complex figure test and Wisconsin card sorting test. Brain structures obtained by magnetic resonance imaging (MRI) were evaluated. The standardised mean difference (SMD) between both groups was calculated, adjusted for confounding variables using a propen-sity score, and the Spearman correlation coefficient (p) was used to assess the relationship between cognitive performance and neuroanatomical regions. Results: Compared to the group without lithium, the group with lithium had fewer perse-verative errors in the Wisconsin test (SMD = -0.69) and greater left and right cortical areas (SMD = 0.85; SMD = 0.92); greater surface area in the left anterior cingulate (SMD = 1.32), right medial orbitofrontal cortex (SMD = 1.17), right superior frontal gyrus (SMD = 0.82), and right and left precentral gyrus (SMD = 1.33; SMD = 0.98); greater volume of the right amyg-dala (SMD = 0.57), right hippocampus (SMD = 0.66), right putamen (SMD = 0.87) and right thalamus (SMD=.67). In the lithium group, a correlation was found with these errors and the thickness of the left precentral gyrus (p = -0.78), the volume of the right thalamus (p =-0.44), and the right amygdala (p = 0.6). Conclusions: Thelithium group had better cognitive flexibility and greater dimension in some frontal and subcortical cortical regions. Furthermore, there was a moderate to high correlation between performance in this executive function and the thickness of the right precentral gyrus, and the volumes of the thalamus and the right amygdala. These findings could suggest a neuroprotective effect of lithium.
RESUMO
Objetivo: Determinar si existen diferencias entre áreas rurales y urbanas de Antioquia en las características asociadas con el suicidio. Método: Se compararon 79 sujetos provenientes de áreas rurales y 75 de áreas urbanas de Antioquia. Se hizo autopsia psicológica y se calcularon razones de prevalencia (RP) (frecuencia de la característica en zona rural/frecuencia de la característica en zona urbana). Resultados: Las características asociadas de manera independiente con provenir de área rural y urbana fueron: momento del suicidio durante la noche (RP = 0,65; IC 95%: 0,48-0,89) y vivir solo (RP = 0,40; IC 95%: 0,17-0,98), que fueron más frecuentes en zona urbana, y envenenamiento con pesticidas, que ocurrió más en zona rural (RP = 1,80; IC 95%: 1,39-2,34). Conclusiones: Los individuos suicidas provenientes de zonas rurales y urbanas tenían características diferentes. Ello puede tener implicaciones para el diseño de las estrategias de prevención del suicidio en cada una de las zonas. Se requieren otros estudios para determinar los factores de riesgo propios de cada área...
Objective: To determine differences in characteristics associated with suicide between rural and urban populations from Antioquia. Method: 79 subjects from rural areas and 75 subjects from urban areas were compared. Psychological autopsy was done and prevalence ratios (PR) (frequency of characteristic in rural zone/frequency of characteristic in urban zone) were calculated. Results: The characteristics that associated independently with coming from rural or urban areas were: suicide during the night (PR = 0.65; 95% CI: 0.48-0.89) and living alone (PR = 0.40; 95% CI: 0.17-0.98), which were more frequent in urban areas, and pesticide poisoning which was more frequent in rural areas (PR = 1.80; 95% CI: 1.39-2.34). Conclusions: Individuals who committed suicide from rural and urban areas have different characteristics. This finding might have implications for the design of preventive strategies in each zone. Additional studies are required to determine specific risk factors in urban and rural areas...
Assuntos
População Rural , Suicídio , População UrbanaRESUMO
Objetivo: Evaluar la estructura factorial, la confiabilidad y la validez de contenido y constructo de una versión en español para Colombia del Inventario de Razones para Vivir (Rfl) en una muestra clínica de sujetos con intento de suicidio. Método: Se hicieron dos traducciones al español y dos traducciones en sentido inverso de cada uno de los ítems. Se examinó la validez del contenido y del constructo, la consistencia interna y la reproducibilidad prueba-reprueba. Resultados: La estructura factorial tiene seis dominios que explican el 63,5% de la varianza: Creencia en la vida y capacidad de afrontamiento, Miedo a la muerte y a la desaprobación social, Responsabilidad con la familia, Preocupación por los hijos, Percepción de incapacidad para el suicidio y Objeciones morales. La consistencia interna fue alta (Alfa de Cronbach=0,96), así como la reproducibilidad prueba-reprueba (CCI=0,89, IC95%: 0,78-0,94). Cuando se evaluó la validez del constructo encontramos diferencias significativas en las puntuaciones del Rflentre individuos con riesgo de suicidio alto y bajo, definido clínicamente. Conclusiones: La versión colombiana del Rflmuestra buenas propiedades psicométricas en una población clínica con comportamiento suicida.
Objective: To evaluate the factor structure, reliability, and construct and content validity of the Colombian Spanish version of the Reasons for Living Inventory (Rfl) in a clinical sample of subjects who attempted suicide. Method: Two translations into Spanish and two back-translations for each of the items were done. We assessed content and construct validity as well as internal consistency and test-retest reproducibility. Results: The factor structure has six domains which explain 63.5% of the variance: survival and coping beliefs, fear of death and social disapproval, responsibility to family, child-related concerns, perception of incapacity for suicide and moral objections. The internal consistency was high (Cronbachs alpha=0.96), as was test-retest reproducibility (ICC=0.89, IC95%: 0.78-0.94). When assessing construct validity, we found significant differences between individuals with clinically defined high and low suicide risk in Rflscores. Conclusions: The Rflversion for Colombia shows good psychometric properties in clinical population with suicidal behavior.
RESUMO
La hipótesis del neurodesarrollo con respecto al origen de la esquizofrenia postula que ésta es producto de una alteración cerebral primaria, resultante de un defecto estructural que ocurre temprano en la vida. Este defecto interactúa con eventos del desarrollo del sistema nervioso central y produce deficiencias que, junto con precipitantes ambientales, llevan a las manifestaciones clínicas de la esquizofrenia. Esta hipótesis ha tenido gran aceptación y ha sido la base de múltiples estudios de genética molecular en los últimos años. En este artículo se revisan los estudios médicos que apoyan dicha hipótesis y aquellos que la controvierten, al mostrar hallazgos de procesos neurodegenerativos dentro del trastorno...